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Radiologic Findings of Ischemic Stroke. Natalia Markiewicz M4 September 24 th 2009. Risk Factors. Most Important: Hypertension Age Other: Smoking, Diabetes Mellitus, Hyperlipidemia, Atrial Fibrillation, CAD, Previous stroke/TIA, Family History.

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radiologic findings of ischemic stroke

Radiologic Findings of Ischemic Stroke

Natalia Markiewicz M4

September 24th 2009

risk factors
Risk Factors

Most Important:

Hypertension

Age

Other:

Smoking, Diabetes Mellitus, Hyperlipidemia,

Atrial Fibrillation, CAD, Previous stroke/TIA, Family History

main subtypes of ischemic stroke
Main subtypes of Ischemic Stroke

Embolic stroke

  • Etiology: Cardiac, Arterial, Aorta, Paradoxical

Thrombotic stroke

  • Etiology: Large and small vessel disease

Systemic hypoperfusion

  • Etiology: Cardiac pump failure, Reduced cardiac output
clinical features
Clinical Features

Embolic stroke

  • Occur suddenly with maximal deficit initially
  • Clinical features depend on the artery occluded

Thrombotic stroke

  • Symptoms progress in a stepwise fashion with some periods of improvement

Systemic hypoperfusion

  • Symptoms are diffuse, nonfocal, and typically bilateral
neuroimaging
Neuroimaging

Non-contrast CT to exclude or confirm hemorrhage

non contrast ct
Non-contrast CT

Patient presents within 0-3hrs of

symptom onset.

What is the next step in the

management of this patient?

Treatment: IV Thrombolytic Therapy

non contrast ct7
Non-contrast CT

Patient presents within 3-6hrs of

symptom onset.

What is the next step in the

management of this patient?

Establishing if there is any DWI/PWI

mismatch:

THE PENUMBRA

penumbra
Penumbra
  • Occlusion of an intracranial vessel leads to a fall in cerebral blood flow to zero, causing death of the brain tissue: core region of infarction (irreversible)
  • Tissue surrounding this core infarction is ischemic but salvageable (the penumbra)
  • The penumbra will eventually die if no change in blood flow occurs
  • Goal of thrombolytic therapy is to save the penumbra by restoring circulation
diffusion weighted imaging
Diffusion-weighted imaging

Reveals evidence of

ischemic injury within

3-30 minutes of onset.

Signal reflects irreversibly

damaged brain tissue.

perfusion weighted imaging
Perfusion-weighted imaging

Measures the passage of

contrast agent such as

gadolinium through the

brain parenchyma over

time.

Constructs maps of cerebral

blood volume.

Detects the entire region of

hypoperfusion.

the importance
The Importance ???

PWI/DWI mismatch: physiological evidence that

there is brain tissue that can be salvaged with successful

recanalization via tPA.

references
References

Harvard University Department of Radiology

www.massgeneralimaging.org

Kidwell, CS, Chalela, JA, Saver, JL, et al. Comparison of MRI

and CT for detection of acute intracerebral hemorrhage.

JAMA 2004; 292:1823.

Smith, WS, English, JD, Johnston, SC. “Ischemic Stroke.”

Harrison’s Online. Chapter 364.

slide13
Questions

Thank you